Michiko Toizumi1, Hideki Motomura2, Hien Minh Vo3, Kensuke Takahashi4, Enga Pham3, Hien Anh Thi Nguyen5, Tho Huu Le6, Masahiro Hashizume1, Koya Ariyoshi4, Duc Anh Dang5, Hiroyuki Moriuchi7, Lay-Myint Yoshida8. 1. Departments of Pediatric Infectious Diseases andDepartments of Tropical Pediatric Infectious Diseases. 2. Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan;Pediatrics, and hideki-m@nagasaki-u.ac.jp. 3. Department of Pediatrics, Khanh Hoa General Hospital, Nha Trang, Vietnam; 4. Clinical Medicine, Institute of Tropical Medicine, andClinical Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan; 5. Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam; and. 6. Department of Planning and Research Collaboration, Khanh Hoa Health Service, Nha Trang, Vietnam. 7. Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan;Pediatrics, and. 8. Departments of Pediatric Infectious Diseases and.
Abstract
OBJECTIVE: Outbreaks of rubella and congenital rubella syndrome (CRS) continue to arise in various countries where a rubella-containing vaccine is not included in the national immunization program. After a large-scale rubella outbreak in 2011, CRS cases emerged in Vietnam. The aim of this study was to clarify the clinical features of these cases with an emphasis on cardiovascular complications and outcomes. METHODS: From October 2011 to September 2012, we conducted a prospective surveillance study of infants <12 months of age who had manifestations suggesting CRS at the only referral hospital in Khanh Hoa Province. These infants underwent standard examinations, echocardiography, cranial ultrasonography, automated auditory brainstem responses, blood cell count measurements, and rubella-specific antibody testing. Detected cardiovascular defects were regularly followed with echocardiography. RESULTS: We enrolled 38 cases of CRS characterized by a low birth weight (71%), cardiovascular defects (72%), cataracts (13%), hearing impairment (93%), purpura (84%), hepatosplenomegaly (68%), and thrombocytopenia (76%). Patent ductus arteriosus, the most common cardiovascular complication, was often associated with progressive pulmonary hypertension (PH). As of January 2013, 13 infants (34%) had died, and PH was significantly more frequent among the fatalities (P = .004); however, therapeutic closure of the ductus reversed the PH in several cases. CONCLUSIONS: PH-associated mortality is high among infants who have CRS in Vietnam. Providing proper assessments, continuous follow-up, and timely intervention for cardiovascular defects is critical for the management of CRS patients. Echocardiography is of diagnostic and prognostic value and can support better clinical management of CRS, even in a developing country setting.
OBJECTIVE: Outbreaks of rubella and congenital rubella syndrome (CRS) continue to arise in various countries where a rubella-containing vaccine is not included in the national immunization program. After a large-scale rubella outbreak in 2011, CRS cases emerged in Vietnam. The aim of this study was to clarify the clinical features of these cases with an emphasis on cardiovascular complications and outcomes. METHODS: From October 2011 to September 2012, we conducted a prospective surveillance study of infants <12 months of age who had manifestations suggesting CRS at the only referral hospital in Khanh Hoa Province. These infants underwent standard examinations, echocardiography, cranial ultrasonography, automated auditory brainstem responses, blood cell count measurements, and rubella-specific antibody testing. Detected cardiovascular defects were regularly followed with echocardiography. RESULTS: We enrolled 38 cases of CRS characterized by a low birth weight (71%), cardiovascular defects (72%), cataracts (13%), hearing impairment (93%), purpura (84%), hepatosplenomegaly (68%), and thrombocytopenia (76%). Patent ductus arteriosus, the most common cardiovascular complication, was often associated with progressive pulmonary hypertension (PH). As of January 2013, 13 infants (34%) had died, and PH was significantly more frequent among the fatalities (P = .004); however, therapeutic closure of the ductus reversed the PH in several cases. CONCLUSIONS: PH-associated mortality is high among infants who have CRS in Vietnam. Providing proper assessments, continuous follow-up, and timely intervention for cardiovascular defects is critical for the management of CRSpatients. Echocardiography is of diagnostic and prognostic value and can support better clinical management of CRS, even in a developing country setting.
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